Despite awareness campaigns, patients aren’t receiving useful radiation dose info

A 40-year-old American undergoing a single abdominopelvic CT exam faces, according to some estimates, a lifetime risk of death due to the ionizing radiation of around 1 in 2,000.

Compare that with the same patient’s much higher chances of dying by getting run over by a motor vehicle as a pedestrian, 1.6 in 1,000, and consider how helpful that kind of comparison might be to the patient prior to receiving the scan.

A new review article shows such communications on relative dose dangers aren’t happening prior to radiographic exams, and the lack owes largely to limited awareness of radiation-induced cancer risks among patients and physicians alike.

The literature review is running in the November edition of the American Journal of Roentgenology.

Diana Lam, MD, of the University of Washington in Seattle, and colleagues recommend that radiologists develop consensus statements, including others like the comparison example above, and launch novel educational initiatives to make sure potential rad-dose risks are communicated directly to patients as part of standard operating procedure.

Lam et al. arrived at their suggestion after performing a systematic literature review on radiation dose and radiation-induced cancer risk awareness, informed consent regarding radiation dose, and communication of radiation-induced cancer risks with patients undergoing medical imaging.

They identified 1,200 references in original research articles from North America and Europe published between 1995 and 2014. Of these, 22 articles met their inclusion criteria.

The researchers found that, despite the greatly increased attention radiation-dose dangers have received in recent years—websites, dose calculators, various patient-aimed communications campaigns—there is still:

• Limited awareness of radiation-induced cancer risks among both patients and physicians;
• Variable inclusion of radiation dose and risks in discussions before CT exams;
• No consensus across the medical community on whose duty it should be to provide patients with risk-and-benefit information; and
• No consensus on what information, exactly and if any, should be communicated.

Given that referring physicians are better able to compare the risks and benefits of competing diagnostic tools in light of patient comorbidities, a “strong argument can be made that referring physicians would be best equipped to present potential radiation risks associated with CT directly to patients,” the authors write.

At the same time, however, radiologists interpreting advanced imaging studies “should remain readily available to help both referring physicians and patients understand the complex nature of potential stochastic radiation risks because they purportedly hold the most expertise regarding ionizing radiation,” according to the authors.

Further, as imaging experts, radiologists “should help lead consensus statement development and future educational efforts for nonradiologists,” Lam and colleagues write. “These future efforts should focus on simple, concise messaging geared directly toward patients and novel, innovative education interventions targeting physicians who are most likely to communicate risks and benefits associated with imaging directly to patients.”